Polycystic Ovary (cont.)

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What causes polycystic ovarian syndrome (PCOS)?

No one is quite sure what causes PCOS, and it is likely to be the result of a number of both genetic (inherited) as well as environmental factors. Women with PCOS often have a mother or sister with the condition, and researchers are examining the role that genetics or gene mutations might play in its development. The ovaries of women with PCOS frequently contain a number of small cysts, hence the name poly=many cystic ovarian syndrome. A similar number of cysts may occur in women without PCOS. Therefore, the cysts themselves do not seem to be the cause of the problem.

A malfunction of the body's blood sugar control system (insulin system) is frequent in women with PCOS, who often have insulin resistance and elevated blood insulin levels, and researchers believe that these abnormalities may be related to the development of PCOS. It is also known that the ovaries of women with PCOS produce excess amounts of male hormones known as androgens. This excessive production of male hormones may be a result of or related to the abnormalities in insulin production.

Another hormonal abnormality in women with PCOS is excessive production of the hormone LH, which is involved in stimulating the ovaries to produce hormones and is released from the pituitary gland in the brain.

Other possible contributing factors in the development of PCOS may include a low level of chronic inflammation in the body and fetal exposure to male hormones.

How is PCOS diagnosed?

The PCOS diagnosis is generally made through clinical signs and
symptoms. The doctor will want to exclude other illnesses that have similar features, such as low thyroid hormone blood levels (hypothyroidism) or elevated levels of a milk-producing hormone (prolactin). Also, tumors of the ovary or adrenal glands can produce elevated male hormone (androgen) blood levels that cause acne or excess hair growth, mimicking symptoms of PCOS.

Other laboratory tests can be helpful in making the diagnosis of PCOS. Serum levels of male hormones ( DHEA and testosterone ) may be elevated. However, levels of testosterone that are highly elevated are not unusual with PCOS and call for additional evaluation. Additionally, levels of a hormone released by the pituitary gland in the brain (LH) that is involved in ovarian hormone production are elevated.

The cysts (fluid filled sacs) in the ovaries can be identified with imaging technology. (However, as noted above, women without PCOS can have many cysts as well.) Ultrasound , which passes sound waves through the body to create a picture of the kidneys, is used most often to look for cysts in the ovaries. Ultrasound imaging employs no injected dyes or radiation and is safe for all patients including pregnant women. It can also detect cysts in the kidneys of a fetus. Because women without PCOS can have ovarian cysts , and because ovarian cysts are not part of the definition of PCOS, ultrasound is not routinely ordered to diagnose PCOS. The diagnosis is usually a clinical one based on the patient's history, physical examination, and laboratory testing.

More powerful and expensive imaging methods such as computed tomography (CT
scan) and magnetic resonance imaging (MRI) also can detect cysts, but they are generally reserved for situations in which other conditions that may cause related symptoms, such as ovarian or adrenal gland tumors are suspected. CT scans require X-rays and sometimes
injected dyes, which can be associated with some degree of complications in certain patients.